Healthcare Provider Details

I. General information

NPI: 1043507742
Provider Name (Legal Business Name): MARK OTTE
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/01/2011
Last Update Date: 05/17/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

640 W 6TH ST
NORTH BEND NE
68649-4430
US

IV. Provider business mailing address

PO BOX 211
DAVID CITY NE
68632-0211
US

V. Phone/Fax

Practice location:
  • Phone: 402-367-7970
  • Fax:
Mailing address:
  • Phone: 402-367-1250
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number689
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: